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PubMed1994

Limited role of barium enema examination preceding colostomy closure in trauma patients.

Whether trauma patients should undergo barium enema (BE) examination of the colon prior to colostomy closure has recently been questioned. To ascertain the utility of BE and its impact on postoperative course in this patient population, we reviewed 86 trauma patients who underwent colostomy closure during a 12-year period at our institution. There were 82 males and four females with an average age of 28 years. Ninety-five percent of the injuries were the result of penetrating trauma. Sixteen patients had rectal injuries. Fifteen of these had BE greater than 6 weeks post-trauma and all showed healing of the injury. Of the 70 patients with colonic injuries, 43 (group 1) had BE prior to colostomy closure. Ninety-eight percent (n = 42) of these studies were negative. The only positive finding did not affect the planned surgical procedure. Group 2 (n = 27) did not have a BE prior to colostomy closure. Overall complication rates were not significantly different between group 1 (18.6%) and group 2 (29.6%). We conclude that BE prior to colostomy closure for colonic injuries yields little useful information and does not affect the morbidity rate prior to colostomy closure. Its routine usage should be abandoned. The role of barium enema in assessing rectal injury status is less clear because of the small number in our series, but probably offers no advantage over proctoscopy.

Adolescent↗
PubMed1999

Colonic resection in trauma: colostomy versus anastomosis.

OBJECTIVES: The management of colonic trauma is well established for simple injuries with primary repair, and ileocolostomy for right-sided injuries that undergo colonic resection. Segmental colon resection for injuries to the left colon can be managed with either an end colostomy or primary anastomosis. A retrospective review was performed to evaluate the outcome and complications associated with colonic resection for trauma to determine the risk factors associated with anastomotic leakage. METHODS: A retrospective review included patients undergoing colonic resection for trauma. The patients were stratified into colostomy, ileocolostomy, and colocolostomy groups. Patient demographics and colon-related complications were collected. Comparison between the colostomy and colocolostomy groups was performed to determine the difference in outcome. The outcome of right-sided colon injuries managed by either an ileocolonic or colocolonic anastomosis was compared. Analysis was performed to identify the factors associated with an increased risk of anastomotic leakage. RESULTS: One hundred forty patients over a 66-month period were included in the analysis. Overall, 41% (57 of 140) of patients developed a colon-related complication; 28% (39 of 140) of patients developed an abscess. Overall, the anastomotic leak rate was 13% (7 of 56) in the colocolostomy group, 4% (2 of 56) in the ileocolostomy group. Right-sided colon injuries managed with a colocolonic anastomosis had a higher incidence of anastomotic leakage than ileocolonic anastomosis, i.e., 14 versus 4% respectively. Of the seven patients who developed a leak from a colocolonic anastomosis, two patients died (29%). Univariate analysis identified an Abdominal Trauma Index Score > or = 25 (p = 0.03) or hypotension in the emergency department (p = 0.001) to be associated with increased risk of developing an anastomotic leak from a colocolonic anastomosis. CONCLUSION: Colonic injuries that are managed with resection are associated with a high complication rate regardless of whether an anastomosis or colostomy is performed. Colonic resection and anastomosis can be performed safely in the majority of patients with severe colonic injury, including injuries to the left colon. For injuries of the right colon, an ileocolostomy has a lower incidence of leakage than a colocolonic anastomosis. For injuries to the left colon, there remains a role for colostomy specifically in the subgroups of patients with a high ATI or hypotension, because these patients are at greater risk for an anastomotic leak. The role of resection and primary anastomosis versus colostomy in colonic trauma requires further investigation.

Adult↗
PubMed2006

Does colostomy prevent infection in open blunt pelvic fractures? A systematic review.

BACKGROUND: Open pelvic fracture is a rare injury. Our aim in this study is to systematically review the literature to define when diverting colostomy is indicated to protect the patient from infection in open blunt pelvic fractures. METHODS: Papers studying open pelvic fractures and the use of colostomy were retrieved through MEDLINE and PUBMED. The papers were critically appraised regarding their methodology and conclusions. Relevant information was combined. RESULTS: The level of evidence for the use of colostomy in open pelvic fractures is very low. All reports are retrospective and no statistical methods have been used to support conclusions drawn. We found no difference in the overall infectious complication rate between the colostomy and noncolostomy groups. There is an assumption that patients with perineal wounds would benefit from colostomy; however, rectal involvement in these injuries was not detailed. CONCLUSION: The role of colostomy in open blunt pelvic fractures is unresolved and randomized multicenter trials are needed.

Colostomy↗
PubMedDate not supplied

Use of colostomy to manage rectal disease in dogs.

OBJECTIVE: The purpose of this study was to develop a diverting colostomy technique for use in dogs. STUDY DESIGN: Clinical case series. ANIMALS: Five client-owned dogs presented for diseases requiring diverting colostomy during treatment. METHODS: Diverting colostomy was performed in five dogs. A ventral approach was used in the first dog and the colon was exteriorized adjacent to the linea alba. The technique used in the next four dogs involved creation of a left flank rod-supported loop colostomy in which the colon was exteriorized through a muscle-separating flank approach to the abdomen. RESULTS: Peritoneal leakage of fecal material resulted in the perioperative death of the first dog. The flank colostomies were maintained for times ranging form 3.5 weeks to 7 months. No major complications were observed, but skin excoriation occurred occasionally around the stoma sites in all dogs. CONCLUSION: Diverting colostomy is a technique that is suitable for use in treatment of dogs with obstruction or leakage involving the distal colon or rectum.

Animals↗
PubMed1992

Effect of colostomy on the circadian rhythm in DNA synthesis in the rat colon.

Synthesis of DNA and mitosis in gut epithelium are not constant or random events but rather are characterized by circadian rhythmicity, which we reported persists even in fasted rats. Others suggest that rhythms persist because rats anticipate food, causing nerve impulses to propagate caudally in the gut at usual meal times, or that digestive products from previous feedings cause rhythms in the lower tract. We studied colonic DNA synthesis in rats that had been given colostomies. In one study, the distal colon was isolated neurally from proximal gut by means of an end colostomy. In a second study, rats were subjected to loop colostomy; some intrinsic innervation of the gut wall remained intact. Sprague-Dawley male rats, 8 weeks old, were acclimated to a 12:12 light-dark cycle. Colostomies were performed after a 48-h fast. The rats were fed ad libitum for 4 weeks after surgery. Operated rats and an equal number (n = 30) of control rats (unoperated) were divided into four subgroups that were killed at 07:00, 13:00, 19:00, and 01:00 h. Each rat was injected with tritiated thymidine 30 min before it was killed. Proximal and distal colon were analyzed for incorporation of radioactivity (DNA synthesis). Results are reported as counts per minute per microgram of DNA and were analyzed using analysis of variance and the t test. Significant daily variation was found in proximal colon, both from control and operated rats. Rhythms were still present in colon distal to loop colostomy but were lost in the distal stump in rats that received an end colostomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1999

[Factors which determine the psychological adjustment to permanent colostomies. An empirical study in Santiago, Chile].

BACKGROUND: The acceptance of a colostomy by a patient requires a great amount of psychological resources and social support. AIM: To identify factors that influence the postoperative adaptation to a colostomy. PATIENTS AND METHODS: Sixty patients subjected to a colostomy in 5 hospitals in Santiago were interviewed. The adaptation to the procedure was assessed using the Olsbrisch Ostomy Adjustment Scale. Three regression equations were elaborated to determine the main predictors associated to adaptation. Control variables such as sex, age and the lapse between the interview and the surgical procedure, were included in the model. RESULTS: The model used identified the simultaneous and combined effects of socioeconomic variables such as education and income on the adaptation to colostomy. A generalized detriment of the self image was detected. Patients valued the social support given by the family and friends. Multiple regression analysis determined that the main predictor of the patient's adaptation to colostomy was the level of self care developed. CONCLUSIONS: The better adaptation to a colostomy could be achieved by training the patient for an adequate self care and providing him with psychological and social support.

Adaptation, Psychological↗
PubMed1999

[Complications of colostomy--how to avoid them].

According to data in the literature complications develop in association with colostomy in 20-66% of patients, occlusion of the colostomy occurs in 10-17%. The authors analyze their own group of 122 patients where in 1994-1998 a colostomy was made. Sixty-two patients were operated with developed ileus, 19 colostomies were later abolished and the passage per vias naturales was reconstructed. The authors recorded 38.5% complications, they were most frequent in axial transversostomies and sigmostomies, wound infections were most frequent. For prevention of complications the authors emphasize that stricter indications for colostomy should be used. The same applies to the selection of the type and site of colostomy and exact surgical technique, ATB prophylaxis and lavage, use of modern stomic appliances, perspectives of using the laparoscopic technique.

Adult↗
PubMed1992

[Colostomy-induced varices in portal hypertension].

Varices of the colostomy are a rare complication of colostomy performed in patients with portal hypertension. This work is based on 14 cases. The colic stomy is the terminal operation in surgery for cancer in twelve cases, and a bypass stomy in two cases. Portal hypertension is due to cirrhosis in 10 cases and to metastases to the liver in 4 cases. All 14 colostomy varices were expressed by bleeding. In 7 cases, oesophageal varices were detected with fiberendoscopy. Only one of these patients had an upper digestive hemorrhage. Colostomy hemorrhages are the revealing complication and the main sign of the disease. The emergent treatment of bleeding of the colostomy must combine several methods, most often consecutively: local compression, ligation, sclerotherapy. Once bleeding is controlled, the radical treatment must be primarily medical (hygienic and dietary habits, beta-adrenergic blocking agents), but complementary surgery may prove to be necessary, most often to redo the colostomy with additional deconnection. The prognosis mainly depends on the function of the liver, the deterioration of which is accelerated by the successive hemorrhagic accidents. Hepatorenal failure is the main cause of death.

Aged↗
PubMed1992

Morbidity after immediate and delayed opening of sigmoid end colostomy: a randomised trial.

OBJECTIVE: To see if sigmoid end colostomies that were opened immediately carried a higher early morbidity than those in which opening was delayed for 10 days. DESIGN: Randomised trial. SETTING: University department of surgical gastroenterology. SUBJECTS: All patients for whom a temporary or permanent end sigmoid colostomy was done between December 1986 and May 1989. INTERVENTIONS: 51 patients had their colostomies opened immediately, and in 49 opening was delayed. MAIN OUTCOME MEASURES: Presence of ischaemia, retraction, separation or infection, and length of stay in hospital. RESULTS: Two patients from each group died within the first week; none of the deaths was associated with complications of the colostomy. One patient whose colostomy had been opened immediately developed gangrene of the stoma, and one in whom the opening had been delayed developed retraction. There was no difference between the groups in length of stay in hospital. CONCLUSION: As we could find no differences in morbidity whether the colostomy was opened immediately or whether it was delayed, we now recommend that it should be done immediately. The question of late complications (stenosis and hernia), however, cannot be answered yet.

Cause of Death↗
PubMedDate not supplied

[A rare complication of colostomy].

A case of a 64 years old female patient who had had a Miles operation 6 years ago for rectal cancer and at the present hospital admission she came in with a severe infection around her left colostomy. Initially, she presented a quite localized peristomal infection but, subsequently, the infection has evolved to an extensive necrotizing fasciitis of the abdomen, a large dehiscence of colostomy and severe sepsis. Repeated surgery and transverse colostomy, to put at rest infected left colostomy, plus aggressive medical treatment resulted in a good recovery, with the wounds healing and redo of the left colostomy. Now she is on the waiting list to get rid of the transverse colostomy.

Abdomen↗
PubMed1987

Penetrating colon injuries: exteriorized repair vs. loop colostomy.

Eighty-five patients with penetrating colon injuries, treated either by exteriorized repair (39) or loop colostomy (46), were analyzed. Missile wounds accounted for 75.3% of the injuries. The Penetrating Abdominal Trauma Index (PATI) was the scoring method employed to assess quantitatively the severity of injuries in each patient. Of 21 patients with right colon injuries, eight were treated by exteriorized repair and the remainder by loop colostomy. PATI and other variables were comparable in both groups. Suture line leaks occurred in two patients (25%) with exteriorized repair. The morbidity was similar in both groups. In left colon trauma, exteriorized repair was employed in 31 patients and 33 underwent loop colostomy. The injury severity indices, clinical status, and time lapse to laparotomy were similar in both groups. Colostomy was avoided in 67.7% (21 of 31) patients with exteriorized repair. The incidence of abscesses was significantly higher in the colostomy group compared to the group treated by exteriorized repair (24.2% and 6.4%, respectively; p less than 0.05). The length of hospital stay was shorter after exteriorized repair (17.2 days vs. 23.2 days; p less than 0.05). All three mortalities (3.5%) were related to associated injuries. We conclude that exteriorized repair is a safe and superior alternative to loop colostomy in penetrating colon trauma.

Adolescent↗
PubMed1987

[Role of protective colostomy in colorectal surgery. Apropos of 68 cases].

A retrospective study was made from the records of 68 patients who had temporary loop colostomy with left colectomy between 1975 and 1985. Six fecal fistula occurred. Two of these patients died in spite of the colostomy. The colostomy closure was complicated by six leakages and four wound infections. The results are compared with those from literature. Finally loop colostomy for protecting an anastomosis keeps good indications with sub-obstructions and acute obstructions without large colectasia, infections without abscess, bowels no or bad prepared, and some low colo-rectal anastomosis. Large bowel obstruction with megacolon, and peritonitis avoid all kind of anastomosis. The colostomy closure is a high colonic surgery procedure. It must occur three months after its formation. A barium enema is necessary before loop colostomy closure.

Adult↗
PubMed1981

Colostomy closure promotes cell proliferation and dimethylhydrazine-induced carcinogenesis in rat distal colon.

The influence of adaptive cell proliferation on colonic carcinogenesis was studied in male Fischer rats with a defunctioning transverse colostomy that was closed 4 wk later. Control observations were made in other rats after colonic transection, repeated at 4 wk, after laparotomy alone, or after permanent colostomy. Tumors were induced by 1,2-dimethylhydrazine (total dose, 300 mg/kg) over 11 wk, starting 2 days after the second operation. After creation of the colostomy, amounts of protein, RNA, and DNA in the distal colon halved in 4 wk (p less than 0.001), but returned to normal 7 days after restoration of colonic continuity. This reactive hyperplasia promoted the development of distal colonic carcinomas, as compared with rats having repeated transection of the bowel (incidence 32% vs. 6%; p less than 0.03). Although the amounts of protein and nucleic acid in the proximal colon were unchanged by transverse colostomy, values increased by 18%-59% 4 wk after colostomy closure (p = 0.05-0.002); nonetheless, the yield of tumors in this segment was unaltered. Suture-line cancers were commoner after repeat transection than after colostomy closure (76% vs. 39%; p less than 0.01). These data confirm the promotional effect of increased cell proliferation on intestinal carcinogenesis.

Animals↗
PubMed1981

Risk factors in colostomy closure.

A retrospective study of 69 patients who underwent colostomy closure between 1973 and 1978 was conducted to evaluate three categories of risk: predisposing risk factors, preoperative interventions, and intraoperative techniques. The overall morbidity rate was 44% with no deaths. Factors associated with a greater complication rate included a divided colostomy (especially Hartmann's pouch), diverticulitis, elderly patients, and lack of preoperative oral antibiotics. Irrigation of the distal segment in divided colostomies and preoperative use of systemic antibiotics in association with oral agents, particularly neomycin-erythromycin, may be effective in decreasing morbidity. Factors that did not influence morbidity included time between colostomy and closure, wound management intraoperatively, the use of systemic antibiotics alone, and the location of loop colostomies. With careful preparation of the patient to combat the documented risk factors, colostomy closure may be safely undertaken in most patients.

Administration, Oral↗
PubMed1997

[Pseudo-continent perineal colostomy. Results and techniques].

OBJECTIVE: This prospective study was conducted to assess functional results obtained after pseudo-continent perineal colostomy using the Schmidt procedure. METHODS: Functional outcome was assessed in 40 patients who had undergone amputation of the rectum for cancer and pseudo-continent perineal colostomy reconstruction between 1989 and 1995 in our institution. The cancer pathology, operative procedure and post-operative care were noted. Morbidity, functional outcome and degree of patient satisfaction were recorded. Mean follow-up was 45 months (18-87) in 100% of the patients. RESULTS: There were no operative deaths. Twenty patients had post-operative complications and 2 patients required early conversion to definitive abdominal colostomy due to severe perineal complications. Function outcome showed normal continence in 4 patients, air incontinence in 23, occasional minimal leakage in 9 and incontinence requiring iliac colostomy in 2. Eighty-six percent of the patients were highly satisfied or satisfied with their continence capacity. DISCUSSION: Pseudo-continent perineal colostomy is a reliable technique which can be proposed as an alternative to left iliac colostomy after amputation of the rectum for cancer if a rigorous procedure is applied: careful patient selection, informed consent, rigorous surgical procedure, daily life-long irrigation of the colon.

Adenocarcinoma↗
PubMed2002

Scintigraphic assessment of colostomy irrigation.

OBJECTIVE: This study aims to evaluate colonic transport following colostomy irrigation with a new scintigraphic technique. MATERIALS AND METHODS: To label the bowel contents 19 patients (11 uncomplicated colostomy irrigation, 8 complicated colostomy irrigation) took 111In-labelled polystyrene pellets one and two days before investigation. 99mTc-DTPA was mixed with the irrigation fluid to assess its extent within the bowel. Scintigraphy was performed before and after a standardized washout procedure. The colon was divided into three segments 1: the caecum andascending colon; 2: the transverse colon; 3: the descending and sigmoid colon. Assuming ordered evacuation of the colon, the contribution of each colonic segment to the total evacuation was expressed as a percentage of the original segmental counts. These were added to reach a total defaecation score (range: 0-300). RESULTS: In uncomplicated colostomy irrigation, the median defaecation score was 235 (range: 145-289) corresponding to complete evacuation of the descending and transverse colon and 35% evacuation of the caecum/ascending colon. In complicated colostomy irrigation it was possible to distinguish specific emptying patterns. The retained irrigation fluid reached the caecum in all but one patient. CONCLUSION: Scintigraphy can be used to evaluate colonic emptying following colostomy irrigation.

Journal Article↗
PubMed2004

Dynamic graciloplasty versus implant of artificial sphincter for continent perineal colostomy after Miles' procedure: Technique and early results.

Abdominoperineal resection (APR) is still the standard surgical treatment of anorectal cancers close to the dentate line. Unfortunately, a permanent iliac colostomy is a severe limitation of the quality of life. Attempts to construct a continent perineal colostomy after anorectal excision have been made over the last 15 years with uncertain benefits. We report on our early results of two different procedures consisting of a laparoscopic approach to abdominoperineal rectal excision, fashioning a perineal colostomy with dynamic graciloplasty or implant of an artificial sphincter. Between 2000 and 2004, a total of six patients underwent laparoscopic abdominoperineal resection or reversal of Miles' procedure and construction of perineal colostomy with dynamic graciloplasty (three cases) or implant of an artificial bowel sphincter (three cases). A diverting loop ileostomy was constructed in all patients to prevent contamination. Data concerning the perioperative management, postoperative morbidity and mortality and function after total anorectal reconstruction at the time of discharge, at postoperative month 1 and after ileostomy closure were collected and evaluated in a prospective non-randomised fashion. No early postoperative complications occurred in both groups. No late complication occurred in the dynamic graciloplasty group, whilst one patient of the artificial sphincter group had an ulceration of the tubing and the control pump through the suprapubic skin and the labium skin respectively on postoperative day 35. Another patient in this group, with an erosion of the transposed colon wall, died of myocardial infarction on postoperative day 75 after removal of the prosthesis. Postoperative stay after artificial sphincter implant and dynamic graciloplasty ranged from 12 to 27 days and 16 to 24 days, respectively. The loop ileostomy was closed at postoperative month 3 in all remaining patients except for one in the dynamic graciloplasty group, who died one day before hospitalization for ostomy closure because of an accidental, not disease/operation related reason. Follow-up of patients of the dynamic graciloplasty and artificial sphincter groups ranged from 3 to 24 months and 2.5 to 9.5 months, respectively. Patients in the dynamic graciloplasty group had no complications and follow-up showed satisfactory continence (SF36 form). All patients in the artificial sphincter group had late local complications with erosion of the prosthesis through the wall, its consequent removal and construction of a permanent iliac colostomy. Laparoscopic APR has been reported to be as safe as open APR. There are no published, available data on laparoscopic APR and laparoscopic reversal of Miles' procedure with total anorectal reconstruction with either dynamic graciloplasty or implant of artificial sphincter. Preliminary results showed that laparoscopic APR and APR reversal with continent perineal colostomy and dynamic graciloplasty may be a possible option in selected patients whilst the implant of an artificial sphincter should not be considered as a safe surgical option in such patients.

Journal Article↗
PubMed1999

Colostomy vs tube cecostomy for protection of a low anastomosis in rectal cancer.

BACKGROUND: Symptomatic anastomotic leakage is the most important surgical complication following rectal resection with intestinal anastomosis. Therefore, the routine use of a protective stoma is suggested by several authors. In our department 2 different techniques are performed to protect the anastomosis. Patients receive either a loop colostomy/ileostomy (C/I) or a tube cecostomy (TC). HYPOTHESIS: No significant difference is noted between C/I and TC for protection of a low anastomosis regarding clinical anastomotic leakage rate, reoperation rate for anastomotic leaks/fistulas, postoperative mortality, and permanent colostomy rate. By avoiding a second operation (for colostomy closure), median hospital stay should be significantly reduced. DESIGN: A retrospective review during 1985 to 1997. SETTING: Tertiary care center PATIENTS: One hundred fifty-eight patients who had undergone anterior resections for rectal cancer were studied. Protective C/Is were used in 19 patients; a TC was fashioned in 30 patients. MAIN OUTCOME MEASURES: Clinical anastomotic leakage rate, reoperation rate for anastomotic leaks/fistulas, postoperative mortality, permanent colostomy rate, and median hospital stay. RESULTS: The rate of anastomotic leaks (C/I, 16%; TC, 17%), fecal peritonitis (C/I, 0%; TC, 10%), reoperation for anastomotic leaks/fistulas (C/I, 0%; TC, 13%), permanent colostomies (C/I, 0%; TC, 7%), and postoperative mortality (C/I, 5%; TC, 0%) did not differ significantly in both groups. Median hospital stay was significantly reduced in patients with TC (C/I, 28 days; TC, 15 days). CONCLUSION: In our patients with low resections for rectal cancer, a C/I for protection of the anastomosis did not improve outcome significantly as compared with a TC. With a properly fashioned TC and adequate postoperative management a second operation (for colostomy closure) can be avoided and the overall hospital stay is significantly reduced.

Aged↗